Every finding on record at Hillcrest Home Care, Inc.

Upon patient record review, 1 of 19 (Patient #14) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient #14 - Patient is a cancer patient and has severe pain related to that cancer being treated with an intravenous patient controlled analgesic pump. The on call record showed that the patients husband called after hours to say patient is in extreme pain, and that he felt the pump wasn't working. The on call triage nurse told the husband to give the patient Tylenol as ordered. There was no evidence of an RN assessment of that pump until the next day.

Upon patient record review 1 of 19 (Patient #8) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #8 - The patient was admitted to hospice care on 06/07/25. There was no evidence that the components of a spiritual assessment were completed until 06/17/25 and no evidence of a coordination note discussing the delay in assessment.

Upon patient record review, 2 of 19 (Patient #2,9) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #2 - Patient on senna and bisacodyl prn - med list did not define the progression of the drug regimen. Corrected onsite. Patient #9 - Patient had orders for Bisacodyl, MiraLAX, Milk of Magnesia and an enema all ordered as prn for constipation. The medication list did not define the progression of the drug regimen. Corrected onsite.

Upon patient record review, 2 of 19 (Patient #2,14) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #2 - On 09/22/25, an after hours call was placed by patient's son regarding the facility and patient's suspected wound on coccyx and was concerned the facility was not treating that wound. The triage nurse placed a call to the facility and found that there was a treatment order and the facility nurse was providing that care. There was no evidence that a timely visit was made by the hospice nurse to follow up on this complaint until 09/25/25. Patient #14 - Patient is a cancer patient and has severe pain related to that cancer being treated with an intravenous patient controlled analgesic pump. The on call record showed that the patients husband called after hours to say patient is in extreme pain, and that he felt the pump wasn't working. The on call triage nurse told the husband to give the patient Tylenol as ordered. There was no evidence of an RN assessment of that pump until the next day.

Upon patient record review, 2 of 19 (Patient #3,5) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #3 - Patients medication list showed patient taking senna prn and lomotil prn for GI problems. There were no problems, goals, or interventions related to GI on patient plan of care. Corrected onsite Patient #5 - The patient's medical record showed an order for ciprofloxin 1 drop in both eyes four times per day for eye infection. There was no problems, goals, or interventions related to infection on patient's plan of care. Corrected onsite

Upon patient record review, 2 of 19 (Patient #2,9) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #2 - The bowel regimen outlined in the physician order included 2 different medications senna and bisacodyl - both prn, with no instruction on the progression of that regimen. Corrected onsite Patient #9 - The bowel regimen outlined in the physician order included Bisacodyl, MiraLAX, Milk of Magnesia and an enema all prn. There was no evidence of the progression of that medication regimen. Corrected onsite

Upon patient record review, 1 of 19 (Patient #5) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #5 - The patient's medication profile noted patient was using nebulized ipratropium and albuterol for shortness of breath. The plan of care did not include a nebulizer as a DME item.

Upon observation and home visits, 1 of 4 (Patient #2) there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #2 - The home visit with the registered nurse, noted upon entry into the patient room, the registered nurse placed her bag on the patient bed. There was no evidence that a barrier was used.

Upon patient record review 1 of 19 (Patient #11) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #11 - There was no evidence that an RN made a supervisory visit since the patient started aide service on 10/02/25.

Upon patient record review, 1 of 19 (Patient #3) did not have evidence that each patient record contains Advance Directives. Patient #3 - Patient had chosen Do Not Resuscitate on admission 07/07/25. The medical record showed that the form was signed by the patient, but did not have a physician signature.

Upon client record review, 2 of 19 (Patient #2,5) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #2 - The initial plan of care noted a wound care order to "clean the wound with soap and water, pat dry, and add calazime then cover with a dressing." It also stated hospice was to perform that wound care once the facility clinicians demonstrated competence in performing that wound care. There was no evidence that a competency was performed, and there was no additional documentation or collaboration with the facility regarding who was to continue to perform that wound care. Patient #5 - The initial plan of care noted a wound care order of Calazinc topically three times per day to stage two on left buttocks. It also stated hospice was to perform that wound care once the facility clinicians demonstrated competence in performing that wound care. There was no evidence that a competency was performed, and there was no additional documentation or collaboration with the facility regarding who was to continue to perform that wound care.

Upon patient record review, 9 of 13 (Patient #2, #3, #4, #5, #6, #7, #8, #9, #10) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #2: The med profile contained Miralax. There was not evidence of a diluent and the direction is unclear. The record indicated that the patient had oxygen at 4L/min via nasal cannula. There was no evidence of oxygen on the medication profile. [corrected on site] Patient #3: The med profile contained hydrocortisone topical PRN without evidence of indication or specific area. The med profile contained ketoconozole topical without evidence of specific area. The profile contained Miralax. There was not evidence of a diluent and the direction is unclear. [corrected on site] Patient #4: The med profile contained Miralax. There was not evidence of a diluent and the direction is unclear. The med profile contained acetaminophen 500mg 2 tablets Q8 hours PRN for pain/fever and Tylenol ES 500mg 2 tabs three times a day however, there was no evidence of maximum allowable dose. [corrected on site] Patient #5: The med profile contained Miralax. There was not evidence of a diluent and the direction is unclear. [corrected on site] Patient #6: The med profile contained oxygen 1-5L instranasal PRN without evidence of indication. The record revealed patient has intrathecal morphine pain pump however, the medication profile did not contain evidence of pain pump medication. The med profile contained lidocaine 4% topical patch without evidence of specific site. The med profile contained trazadone 50mg PRN HS without evidence of indication. [corrected on site] Patient #7: The med profile contained oxygen 1-5L intranasal PRN and lorazepam tablet PRN without evidence of indication. The med profile contained Miralax. There was not evidence of a diluent and the direction is unclear. [corrected on site] Patient #8: The med profile contained acetaminophen without evidence of maximum allowable dose. (12/04/2021 acetaminophen 650mg rectally every 6 hours PRN and 08/08/2022 acetaminophen 500mg tablet take 2 tablets three times per day.) The med profile contained nystatin topical without evidence of specific area. [corrected on site] Patient #9: The med profile contained acetaminophen without evidence of maximum allowable dose. (08/30/2021 acetaminophen 500mg take 3 tablets twice a day and 06/14/2021 acetaminophen 500mg tablet take 2 tablets every 8 hours PRN pain/fever.) The med profile contained polyethylene glycol oral powder. There was not evidence of a diluent and the direction is unclear. [corrected on site] Patient #10: The med profile contained xylocaine and minerin topical without evidence of specific area. The med profile contained Miralax. There was not evidence of a diluent and the direction is unclear. [corrected on site]

Upon patient record review, 1 of 13 (Patient #4) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #4: The patient was admitted for malignant neoplasm of parietal lobe however, there was not evidence of neurological problems/interventions/goals. corrected on site

Upon patient record review, 9 of 13 (Patient #2, #3, #4, #5, #6, #7, #8, #9, #10) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #2: There was an order on 11/07/2022 Miralax oral powder. There was not evidence of a diluent and the direction is unclear. The record indicated that the patient had oxygen at 4L/min via nasal cannula. There was no evidence of an order for oxygen. [corrected on site] Patient #3: There was an order for hydrocortisone 2.5% topical PRN without evidence of indication or specific area. There was an order for ketoconozole 2% topical PRN for dry itchy skin without evidence of specific area. [corrected on site] Patient #4: There was an order for Miralax oral powder. There was not evidence of a diluent and the direction is unclear. There were orders for acetaminophen 500mg 2 tablets Q8 hours PRN for pain/fever and Tylenol ES 500mg 2 tabs three times a day however, there was no evidence of maximum allowable dose. [corrected on site] Patient #5: There was an order for Miralax oral powder. There was not evidence of a diluent and the direction is unclear. [corrected on site] Patient #6: The record revealed patient has intrathecal morphine pain pump however, there was no evidence of an order for medication. There was an order for lidocaine 4% topical patch without evidence of specific area. There was an order for trazadone 50mg PRN HS without evidence of indication. The nurse note indicate she delivered TED hose and edema wear however, the was no evidence of an order for these items. [corrected on site] Patient #7: There was an order for oxygen 1-5L intranasal PRN without evidence of indication. There was an order for Miralax oral powder. There was not evidence of a diluent and the direction is unclear. [corrected on site] Patient #8: There were two orders for acetaminophen without evidence of maximum allowable dose. (12/04/2021 acetaminophen 650mg rectally every 6 hours PRN and 08/08/2022 acetaminophen 500mg tablet take 2 tablets three times per day.) [corrected on site] Patient #9: There were two orders for acetaminophen without evidence of maximum allowable dose on 08/30 order. (08/30/2021 acetaminophen 500mg take 3 tablets twice a day and 06/14/2021 acetaminophen 500mg tablet take 2 tablets every 8 hours PRN pain/fever.) There was an order for polyethylene glycol oral powder. There was not evidence of a diluent and the direction is unclear. [corrected on site] Patient #10: There were orders for xylocaine and minerin topical without evidence of specific area. There was an order for Miralax. There was not evidence of a diluent and the direction is unclear. [corrected on site]

Upon patient record review, 1 of 13 (Patient #3) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #3: The nurse note on 10/29/2022 noted she placed a foley catheter, however there was no evidence this was included on the plan of care. The nurse note indicate she delivered TED hose and edema wear however, the was no evidence this was included in plan of care. corrected on site

Upon client record review, 3 of 6 applicable (Patient #2, #3, #6) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2 Nursing visits were ordered as 1 per week and 3 prn visits. There is documentation of 2 visits the week of 10/02/22 and 10/16/2022. There was no evidence that any of these visits were PRN visits. The nurse notes indicated that the patient's medication planner was being filled weekly by hospice staff however, there was no evidence this was included in plan of care. corrected on site Patient #3 The nurse note on 10/29/2022 noted she placed a foley catheter, however there was not evidence of an order. Nursing visits were ordered as 1 per week and 5 prn visits. There is documentation of 2 visits the weeks of 10/02/22, 10/16/2022, and 10/30/2022 and 3 visits the week of 10/23/2022. There was no evidence that any of these visits were PRN visits. [corrected on site] Patient #6 Nursing visits were ordered as 1 per week and 3 prn visits. There is documentation of 2 visits on 10/03/22 and 10/06/2022. There was no evidence that any of these visits were PRN visits. [corrected on site]

Upon patient record review 3 of 11 applicable (Patient #2, #4, #9) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #2: Aide visits were ordered as 1 per week and 3 PRN. There is documentation of of 2 visits the week of 10/09 and 10/30/2022. There was no evidence that any of these visits were PRN visits. corrected on site Patient #4: Aide visits were ordered 3 per week and 3 PRN however, the week of 09/04/2022 there was only evidence of two visits. corrected on site Patient #9: Aide visits were ordered 1 per week and 3 PRN. There is documentation of of 2 visits the week of 10/09, 10/16, 10/23 and 10/30/2022. There was no evidence that any of these visits were PRN visits. corrected on site

Upon personnel record review, 1 of 9 applicable (Personnel #10) did not have evidence that the hospice employees have received orientation on their specific job requirements. Personnel #10: There was not evidence of orientation specific to volunteer.

Upon patient client record review, 2 of 13 (Patient #11, #12) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #11: The POA elected to receive addendum for notice of non-covered items however, there was not evidence of signed copy. Patient #12: The POA elected to receive addendum for notice of non-covered items however, the addendum was not sent until 09/22/2022 and was requested 09/14/2022.

Upon patient client record review, 2 of 13 (Patient #5, #8) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #5: The plan of care contained music therapy however, there was no evidence of an ordered visit frequency or visit. Upon review the agency discovered this was added to plan of care in error. corrected on site Patient #8: The music therapist noted attempts for visits however, there was no evidence of visit frequency. Upon review this is an EMR issue pulling old information.

Upon observation, there was no evidence a copy is provided of the hospice written policies and procedures on the management and disposal of controlled drugs to the patient or patient representative and family. Upon review of admission packet and interview with administrator and DON, there was no evidence that patient was provided with written policies and procedures on the management and disposal of controlled drugs. corrected on site

Upon client record review, 2 of 7 applicable (Patient #7, #9) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #7: The spiritual care visits were ordered 09/01/2022 1M2, 2 PRN however, there was no evidence of visit in September or October. The volunteer visits were ordered 4m1, 5 PRN on 09/24 and 3m2, 4 PRN on 10/24 however, there was only evidence of 3 visits in September and 7 visits in October. corrected on site Patient #9: The nursing visits were ordered to begin on 10/07/2022 1 per week and 3 PRN however, there was no evidence of a nursing visit completed.

Upon observation, there was no evidence the organizational chart matches the hospice's information submitted to CMS and/or State licensing agencies for ownership and management personnel. The agency could not furnish update of new alternate administrator/DOCS that started 04/2021.